Hookworm, a disease of extreme poverty, is thriving in the US south. Why?

Exclusive: in America, the worlds richest country, diseases that thrive amid poverty are rampant, the first study of its kind in modern times shows

Children playing feet away from open pools of raw sewage; drinking water pumped beside cracked pipes of untreated waste; human faeces flushed back into kitchen sinks and bathtubs whenever the rains come; people testing positive for hookworm, an intestinal parasite that thrives on extreme poverty.

These are the findings of a new study into endemic tropical diseases, not in places usually associated with them in the developing world of sub-Saharan Africa and Asia, but in a corner of the richest nation on earth: Alabama.

Scientists in Houston, Texas, have lifted the lid on one of Americas darkest and deepest secrets: that hidden beneath fabulous wealth, the US tolerates poverty-related illness at levels comparable to the worlds poorest countries. More than one in three people sampled in a poor area of Alabama tested positive for traces of hookworm, a gastrointestinal parasite that was thought to have been eradicated from the US decades ago.

The long-awaited findings, revealed by the Guardian for the first time, are a wake-up call for the worlds only superpower as it grapples with growing inequality. Donald Trump has promised to Make America Great Again and tackle the nations crumbling infrastructure, but he has said very little about enduring chronic poverty, particularly in the southern states.

The study, the first of its kind in modern times, was carried out by the National School of Tropical Medicine at Baylor College of Medicine in conjunction with Alabama Center for Rural Enterprise (ACRE), a non-profit group seeking to address the root causes of poverty. In a survey of people living in Lowndes County, an area with a long history of racial discrimination and inequality, it found that 34% tested positive for genetic traces of Necator americanus.

The parasite, better known as hookworm, enters the body through the skin, usually through the soles of bare feet, and travels around the body until it attaches itself to the small intestine where it proceeds to suck the blood of its host. Over months or years it causes iron deficiency and anemia, weight loss, tiredness and impaired mental function, especially in children, helping to trap them into the poverty in which the disease flourishes.

Hookworm was rampant in the deep south of the US in the earlier 20th century, sapping the energy and educational achievements of both white and black kids and helping to create the stereotype of the lazy and lethargic southern redneck. As public health improved, most experts assumed it had disappeared altogether by the 1980s.

But the new study reveals that hookworm not only survives in communities of Americans lacking even basic sanitation, but does so on a breathtaking scale. None of the people included in the research had travelled outside the US, yet parasite exposure was found to be prevalent, as was shockingly inadequate waste treatment.

The peer-reviewed research paper, published in the American Journal of Tropical Medicine and Hygiene, focuses on Lowndes County, Alabama the home state of the US attorney general, Jeff Sessions, and a landmark region in the history of the nations civil rights movement. Bloody Lowndes, the area was called in reference to the violent reaction of white residents towards attempts to undo racial segregation in the 1950s.

It was through this county that Martin Luther King led marchers from Selma to Montgomery in 1965 in search of voting rights for black citizens, More than half a century later, Kings dream of what he called the dignity of equality remains elusive for many of the 11,000 residents of Lowndes County, 74% of whom are African American.

People are scared. They dont like to speak out as theyre worried the health department will come round and cause trouble, Thigpen said.

The challenge to places like Lowndes County is not to restore existing public infrastructure, as Trump has promised, because there is no public infrastructure here to begin with. Flowers estimates that 80% of the county is uncovered by any municipal sewerage system, and in its absence people are expected and in some cases legally forced to provide their own.

Even where individuals can afford up to $15,000 to install a septic tank and very few can the terrain is against them. Lowndes County is located within the Black Belt, the southern sweep of loamy soil that is well suited to growing cotton and as a result spawned a multitude of plantations, each worked by a large enslaved population.

The same thing that made the land so good for cotton its water-retaining properties also makes it a hazard to the thousands of African Americans who still live on it today. When the rains come, the soil becomes saturated, overwhelming inadequate waste systems and providing a perfect breeding ground for hookworm.

Ruby Rudolph lives just beside the main Selma to Montgomery road where King led the protest walk. On the other side of the road theres a brown history placard to mark the spot where her grandmother, Rosie Steele, ran a campsite for the weary marchers.

After they moved on and the campsite was cleared, Rudolph said, her grandmothers grocery store was set on fire in an arson attack. She was 13 at the time, and can remember the flames leaping into the night sky.

Rudolph, now 66, does have her own septic tank at the back of her house, which she shows us in the sweltering 41C (105F) heat. But it doesnt function properly and when it rains the tank spills over, spreading raw waste all over the yard. Thats better than when it flushes back into the house, and Ive had that too, she said.

Shes been told a replacement system would cost her at least $12,000, which is beyond her means. She runs through her finances: she gets up at 4am every day to do an early shift at a Mapco convenience store, which brings in less than $1,200 a month. From that amount she has to pay $611 for her mortgage and theres the electricity bill that can be more than $300 a month when its hot and the air conditioning is busy. Theres not a lot left to put toward a new tank.

This is the inconvenient truth that nobody in America wants to talk about, he said. These people live in the southern United States, and nobody seems to care; they are poor, and nobody seems to care; and more often than not they are people of color, and nobody seems to care.